Letter: Medicare disadvantage: Buyer beware

The Steamboat Pilot & Today recently published an article touting the “benefits” of Medicare Advantage insurance. The most insightful statement in the article was “Make sure you do your research.” While doing your research, please be aware of Medicare Advantage pitfalls, which are many.

First, a quick lesson on what we are dealing with: A Medicare Advantage Plan, also called a Part C, may sound enticing. It combines Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drug coverage) into one plan. These plans cover all Medicare services, and some offer extra coverage for vision, hearing, dental and gym memberships.

Medicare Advantage Plans can be less expensive if you are healthy but are more expensive when you get sick. These plans’ incentives are profits — for insurance companies. This is accomplished by covering less health care, limiting networks of providers and requiring prior authorizations for expensive procedures. Medicare Advantage plans work to avoid sick people.

For Medicare Advantage insurance companies, the more health care they cover, the smaller the profits. This perverse incentive leads to denials and delays of care (the reasons for prior authorizations). Never mind that more than 75% of appeals against denials patients win; most patients are too sick and stressed to appeal, letting insurers win.

Medicare Advantage plans structure co-pays and deductibles to discourage people who are sick. That should tell us something right there: Sick people are at a disadvantage with Medicare “advantage” plans. Patients who get lured into Medicare Advantage plans often feel betrayed when illness strikes; what they need isn’t covered, deductibles are high, co-pays are high, and pre-authorizations are often turned down.

Maybe we should ask ourselves: Do we want to be filling the pockets of for-profit corporations who get their profits by denying care? Perhaps we should call it Medicare Disadvantage?

Before choosing a Medicare Advantage plan, be sure to read the fine print and get a comprehensive list of all co-pays and deductibles. Also, find out if all your doctors accept the plan and all the medications you take will be covered.

Final note: Try not to ever get sick while on one of these plans because the out-of-pocket costs could require a loan or a second mortgage on your home. Buyer beware.

Nancy Spillane

Oak Creek

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